TODAY'S AJENDA #58

Hey! Before we dive into today’s Ajenda, I want to give a massive congratulations to those of you who finished Phase 1 of The Wellness Experiment! 🎉 It’s been truly incredible watching you go through this journey and get stronger—both inside and out.

Here’s an example of what you shared about what you learned: 

But who said the journey stops here? I’m amazed at how many of you have signed up and are continuing your wellness experiment with Phase 2! The energy and excitement is next level—and rightfully so! Phase 2 is where the results really start to kick in.

If you haven’t joined The Wellness Experiment yet, this could be your transformation story too. Even if you haven’t worked out in forever. Even if you have no idea where to begin. Even if you are 86 (yes, we have an 86 year young member right now!). This program was made for women of all fitness levels.  

But the first step? It’s to say “yes” to this exciting new chapter before the promotional rate disappears. We’d love to have you join, and you can sign up for the next cohort below!

When it comes to making smarter choices about alcohol, I often get asked whether some types are “better” than others. The answer might technically be “yes,” but that answer comes with an asterisk the size of your hangover.  

Let’s be clear: Alcohol remains a toxin no matter how organic or artisanal the label. It is definitely NOT a health beverage! That said, if you do choose to drink, some options carry fewer penalties. Here’s how to sip smarter when you decide to indulge:

The “Better” Alcohol Choices 

1. Clear Spirits 

Martinis > Manhattans. Clear spirits, such as gin, vodka, and blanco tequila, typically contain fewer congeners—compounds produced during the fermentation and distillation of alcohol—than dark liquors. 

Congeners, such as tannins and acetaldehyde, aren’t exactly our friends. Research suggests that alcoholic beverages with more congeners usually cause a worse hangover than drinks with fewer. (Rohsenow et al., 2010). This is one reason why some people report feeling "better" after drinking clear spirits compared to darker options.

Here are drinks ranked by their congener content from highest to lowest (if you’re a red wine lover, I apologize in advance):

2. Pure Alcohol 

Say you go with blanco tequila instead of whiskey. Good start! The next step is to drink it pure, since it has fewer additives and lower residual sugar than flavored spirits, liqueurs, or sweet mixed drinks.

I know, I know. Tequila alone isn’t exactly as mouth-watering as a spicy japaeño margarita. But by avoiding the sugary mixers, you’ll minimize blood sugar spikes and consume fewer calories, which is better for your metabolic health. Plus? Drinking it straight comes with another benefit: 

3. Slow Sipping  

I say this from personal experience of over a decade: You tend to drink way less when sipping clear alcohol. 

Consider a margarita, brimming with sickly-sweet triple sec, citrus juice, and agave syrup, versus blanco tequila on the rocks. One gets demolished relatively quickly. The other, you really need to sip as it gets diluted with ice (unless you’re having that kind of day). 

As you’ve probably gathered by now, tequila is my spirit of choice. I’ve run multiple experiments with other alcohols, and my body feels the “best” after tequila—zero bloat, zero fatigue, zero headache. But then again, I never ever have more than 1 or 2 servings. Ever. 

But not all tequila is created equal: 

4. Opt For Blanco Tequila 

I go for blanco tequila made with 100% blue agave. My favorites are Casamigos Blanco and Cincoro Blanco. Agave contains natural compounds called fructans, and research suggests they could have prebiotic effects and digestive benefits (Franco-Robles et al., The Scientific World Journal, 2015).  

But don’t swap your kombucha and coconut yogurt for tequila just yet. Once agave is distilled, many of those fructans are broken down, and the health impact becomes minimal. 

Is There Such a Thing As a  “Safe” Amount of Alcohol? 

Honestly? No. Even drinking small amounts of alcohol carries risks, including increased breast cancer rates in women (American Cancer Society, 2020).  

Does this mean you should never drink? That’s a personal choice! But if you do, choose clear, pure spirits, avoid sugar-loaded mixers, stay hydrated, and sip slowly.

There’s also the option to taste tequila’s rich flavor profile without the hangover. Seriously! Wild Sol salsas*—created by two-time World Series Champion, Alex Bregman and wife, Reagan—contains actual tequila (or mezcal) but cooks out so it’s 100% non-alcoholic. 

The result is a wildly different and incredibly tasting salsa with a depth of flavor you just don’t usually find on the salsa aisle. My personal favorite is the Mango Habanero which uses Flecha Azul Reposado Tequila. 

I’m stocking up on these salsas for Cinco De Mayo celebrations next week (and yes, maybe some tequila too…). If you’re planning on doing the same, you can use the code AJENDA for 15% off your Wild Sol order.  

Here’s to salsa that speaks to our sol!

So, you packed away the tampons and pads, thinking those monthly visits were finally over—until suddenly, bleeding! Cue the sighs, eye rolls and perhaps some cursing. 

You’re not alone. Millions of women have experienced irregular vaginal bleeding during and after menopause. (I’m one of them.) While this is quite common, any unexpected bleeding warrants prompt* evaluation to rule out any serious conditions. 

(*By prompt, I mean within the month, although this is not written in stone. It could be within a few weeks, but definitely not “It can wait until next year’s gyn visit” either. And it’s not a “I need to go to the ER today” unless the bleeding is hemorrhage level.)  

Regardless, this situation can feel concerning and scary, though the vast majority of cases won’t be serious. Here’s what might be causing your unexpected visitor:

Perimenopausal Bleeding 

The 4-8 year transitional phase before your body enters menopause—known as perimenopause—can be intense on your body.

During this phase, your ovaries produce less estrogen, but the decline isn’t always steady. Instead, hormonal levels fluctuate dramatically. This hormonal roller coaster can lead to irregular periods, spotting, or heavier-than-usual bleeding. 

It can also make existing uterine fibroids (non-cancerous muscle growth in your uterus) or polyps (tissue attached to the inner wall of your uterus) grow larger, triggering more bleeding. 

Postmenopausal Bleeding (PMB) 

Once those 4-8 years close out, you’re on to the next phase: Menopause. At this point, once you’ve stopped getting your period for a year straight, any vaginal bleeding is considered “abnormal.” 

But irregular bleeding does happen! Here’s what might cause it:

1. Thinning Tissue: The most common cause (up to 60% of cases) is that your vaginal and uterine tissues have simply become thinner and more fragile due to lower estrogen levels. This condition makes tissues more prone to bleeding from minor irritation, which is why some women bleed after sex! 

2. Growth in the Uterus: This includes harmless polyps, but it could also be the more harmful endometrial hyperplasia (the abnormal thickening of the uterine lining). 

3. Endometrial Cancer: While less common (only up to 10% of cases), this type of uterine cancer is why doctors take postmenopausal bleeding seriously. 

4. Changing Dose or Timing of Hormone Replacement Therapy: If you are on HRT and miss a dose, start or stop pills, bleeding can occur. This is common.  

How Do I Know If My Bleeding Is “Normal?” 

Before seeing your OBGYN, there are a few details you’ll want to gather: 

• Color: Is it dark brown (older blood) or bright red (fresh blood)? 

• Cramps: Are you cramping with the bleeding? 

• Source: Is the blood coming from the vagina? I know it sounds obvious, but trust me—it sometimes isn’t. Insert a tampon to be sure. 

• Pattern: Does it stop and start? Or is it a heavier flow? 

• Amount: Is it just a few spots or enough to need a pad? 

• Hormones: If you’re on any hormones, did you miss any doses? 

What Your Doctor Will Do

Usually, your doctor will administer an ultrasound to measure your uterine lining thickness. If it’s less than 4mm, the cancer risk is low. But if it’s thicker than 5mm (or if ultrasound results are inconclusive)? Your doctor will recommend an endometrial biopsy to obtain tissue samples for further analysis. This biopsy can be done: 

1. In an office (with some cramping). 

2. In an operating room under anesthesia. 

If you’re a woman who is many years post menopause or whose never given birth vaginally, there’s a chance your cervix will be tighter. So, for safety (and comfort!) reasons, you’ll probably be recommended the latter. 

Types of Treatment 

Based on what’s causing your bleeding, treatment might look like: 

• Thinning Vaginal Tissue (Atrophic Vaginitis) ➜ Topical estrogen therapy, such as creams, rings, or tablets inserted directly into the vagina. 

• Polyps or Fibroids ➜ In some cases, surgical removal (such as a hysteroscopy, which uses a camera to see and remove growths). 

• Endometrial Hyperplasia ➜ Progestin therapy (pills, shots, or IUD to thin out the lining) or surgical interventions such as dilation and curettage (D&C). 

In short, during perimenopause, irregular bleeding episodes are pretty normal. However, if you’ve already been period-free for 12 months straight and then notice bleeding, it could be time to investigate. 

While most cases won’t be serious, prompt check-ups ensure that if something is amiss, you’ll catch it early when treatment options are simpler and more effective. Until then, it might be worth it to keep those “Just in case” tampons around a little longer!

It’s being hailed on social media as “Nature’s Ozempic.” But is it really worth the hype? 

Meet berberine. This yellow, bitter natural compound is extracted from several plants, including the Berberis species like barberry, goldenseal, and Oregon grape. 

While it’s been a staple in Chinese and Ayurvedic medicine for thousands of years, treating everything from infections to digestive issues to inflammatory conditions, today it’s famous for its (supposed) weight loss side effects. 

But can berberine actually help with weight management, particularly with visceral fat (the fat stored deep within the abdominal cavity)? Here’s some mini-med school on berberine.

What is Berberine, Exactly? 

Berberine is an alkaloid, which is a naturally occurring compound with potent biological effects. But what makes berberine particularly interesting is that it acts at a cellular level. 

Berberine activates an enzyme in our body called the AMP-Activated Protein Kinase (AMPK). Think of AMPK as your body’s “Metabolic Master Switch.” When berberine flips this switch on, it can help regulate how your body uses energy. 

What Does The Science Say? 

Lab studies show that berberine works in two ways with our fat cells: 

1. It prevents existing fat cells from getting bigger. 

2. It encourages the body to create smaller fat cells (adipocytes) that respond better to insulin. 

Why does this matter? These smaller, more responsive fat cells may improve how your body processes sugar and reduce inflammation in visceral fat tissue. This could explain why berberine supplements have been linked to modest reductions in body mass index (BMI) and waist size in some clinical trials (Xiong et al., 2020). 

But here’s where things get interesting: 

Berberine doesn’t just impact regular fat—it activates brown adipose tissue (BAT), a special type of fat that burns calories to generate heat.

By ramping up this internal furnace, berberine appears to accelerate metabolism, which explains why a study found that just one month of berberine treatment led to reductions in body weight and improvements in insulin sensitivity in people with fatty liver disease (Wu et al., 2019). 

The Cons of Berberine 

These findings are promising—but let’s not get ahead of ourselves! Berberine isn’t exactly the metabolic miracle some TikTok influencers might have you believe: 

• Berberine’s effects are modest compared to other FDA-approved weight loss medications (such as Ozempic or Wegovy). 

• Berberine may not interact well with certain medications. 

• Pregnant or breastfeeding? This supplement isn’t for you as there is a concern that it passes into the placenta and breastmilk. 

• Potential side effects include cramping, diarrhea, and gastrointestinal discomfort. 

• Berberine’s bioavailability (how much your body absorbs) is relatively low unless formulated carefully.

Bottom line? Berberine has the potential to reduce belly fat and improve your metabolic health (especially if you pair it with diet and exercise). But before you jump on the berberine bandwagon, consult with your healthcare provider to see if this supplement deserves a spot in your medicine cabinet. 

Thanks @b.lynn52 for this great question! If you’d like to submit your own question, you can do so on my Instagram right here.

Did you enjoy Today’s Ajenda? It would mean the world if you left us a testimonial!

ABOUT DR. JEN

In her former roles as chief medical correspondent for ABC News and on-air cohost of “GMA3: What You Need to Know,” Dr. Jennifer Ashton—”Dr. Jen”—has shared the latest health news and information with millions of viewers nationwide. As an OB-GYN, nutritionist, and board-certified obesity medicine specialist, she is passionate about promoting optimal health for “the whole woman.” She has authored several books, including the national best-seller, The Self-Care Solution: A Year of Becoming Happier, Healthier & Fitter—One Month at a Time. And she has gone through menopause…

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